Charlie Robinson's Blog

GUEST SPEAKER FOR CAREGIVERS

CHARLIE ROBINSON will be the guest speaker at the meeting of the Largo Caregivers Support Group on Friday, January 27, 2012, at the Church of Christ Fellowship Hall located at 11025 131st Street in Largo, Florida (just south of the Neighborly Care Network Day Care Center), starting at 9:30 am until 11:30 am. Mr. Robinson will be discussing Asset Protection Planning, Medicaid Planning and the new Durable Power of Attorney. Interested readers are invited to attend.

LONG TERM CARE PLANNING

MOST AMERICANS DON'T PREPARE FOR LONG TERM CARE PLANNING, SURVEY SAYS.

Nearly eight out of ten Americans acknowledge the increasing need for long term care (LTC) planning, yet nearly half (45%) aren't sure how they will address future LTC needs, according to a study released by Northwestern Mutual Life Insurance Company.

The study also found that almost two-thirds of people believe the cost of providing LTC services will rise faster than the return on their savings, and that slightly over half believe that long term care costs will double in the next 14 years. Yet, less than one-third are currently saving for future LTC needs.

"There is a clear disconnect between what Americans understand about long term care needs and the steps they've taken to prepare," said Steve Sperka, Northwestern Mutual vice president of long term care. "In order to create flexibility and options in retirement, people need to address long term care risk as part of financial security planning."

Northwestern Mutual's survey was conducted online by Harris Interactive from October 11-13, 2011, and comprised 2,194 American adults ages 18 and older. According to the survey, an estimated 27% of women report that they have been a caregiver compared to 22% of men. Additionally, two-thirds of women polled said that they're more likely to report that the physical demand of caregiving is their biggest challenge versus less than 50% of men. Compounding the issue is the fact that women, on average, live five years longer than men, according to data from the Centers for Disease Control. Despite this fact, the study showed that fewer women are saving for their future needs (24% for women vs. 32% for men).

"There is no doubt that long term care is a pronounced issue for women, who tend to live longer and are more likely to provide care during their lives," Sperka added. "This just amplifies the importance of planning for women, in order to maintain control over their finances and lifestyle through retirement."

See my website www.charlie-robinson.com for more information on long term care planning.

FLORIDA MEDICAID 2012

MEDICAID 2012

MEDICAID QUALIFICATIONS 2012 during and after Application Process

• Medicaid applicant available asset limit in 2012 is $2000.
• Medicaid applicant gross income limit in 2012 is $2094.
• Community Spouse available asset limit in 2012 is $113,640.
• Home Equity Exemption in 2012 is $525,000.
• Assets below the Medicaid limit one day of the month of application.

MEDICAID APPLICANT

During Application: Asset Limit under $2000---Income Limit under $2094

After Approval: Asset Limit under $2000 ---Income Limit under $2094.

COMMUNITY SPOUSE

During Application: Asset Limit under $113,640---Income Limit No Limit

After Approval: No Limit---Income Limit No Limit

Qualifications for Florida Institutional Care Program (ICP) Medicaid

• Appropriately placed in a nursing home.
• Determination by personal physician.
• Evaluation done by CARES unit of Department of Elder Affairs (DOEA).
• Assets for Medicaid applicant under $2,000 one day of every month of Medicaid benefits.
• Income for Medicaid applicant under $2,094 or a Qualified Income Trust (QIT) in place and funded.
• Gross income includes any deductions such as Medicare Part B premium deduction from Social Security.
• Qualified Income Trust must be established and gross income deposited in QIT account the first month of qualification.
• Income must be deposited into QIT account each month.
• Under no transfer penalty.
• A transfer of assets for less than market value to somebody other than a spouse causes a period of ineligibility.
• Application for Medicaid benefits is not made until all of the abovfe criteria have been met. Applying too soon may cause additional disqualification for benefits.

See my website: www.charlie-robinson.com for details.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WHAT IS A DURABLE POWER OF ATTORNEY ?

Major changes that affect everyone who has or may need to have a Durable Power of Attorney went into effect October 1, 2011. It is critical that everyone who has a Durable Power of Attorney or may be an Agent for someone understands these changes. A Durable Power of Attorney is an extremely important and powerful document. You should consult with a Florida attorney who specializes in the area of law that currently affects your life. A Durable Power of Attorney form copied from a book or drafted by a non-lawyer may not be valid if all the provisions of the new Florida Durable Power of Attorney law are not followed. There are now specific options, duties and powers that you may elect to allow your Agent to perform. A generic form document will not advise you on the importance of your choices.

Q. Can an Agent be paid under the new Durable Power of Attorney?

Q. What are the duties of the Agent under the new Durable Power of Attorney?

Q. What are “Superpowers”?

These are some of the questions that I answer in my article about the new Florida Power of Attorney Act on my website: www.charlie-robinson.com. Click on “Articles” and select “Florida Durable Power of Attorney Questions and Answers as of October 1, 2011.”

NEW FLORIDA POWER OF ATTORNEY

A new Florida Durable Power of Attorney statute went into effect on October 1, 2011. The Act applies to all powers of attorney, regardless of the date the powers were created. I will provide you with some details of the significant provisions in the new Statute in this post and future posts.

Protection of the person granting the power (the principal) is foremost in the minds of the legislators. They recognized that it is desirable to make available to the citizens of Florida a system that provides incapacitated persons the least restrictive alternatives to ensure their physical health and safety, protect their rights and manage their financial resources, while providing protection to the principal and clear guidance to the agent (the person to whom the power is given).

In doing so they designated certain powers that may be exercised by an agent only upon the specific signed authority by the principal. Those powers have been designated Super Powers. Each grant of authority must be signed or initialed by the principal on the document itself at the location of that power. Included in these powers is the authority to create a trust; to modify, revoke or terminate an existing trust; to change rights of survivorship; to change a beneficiary; to waive any rights of the principal to an annuity or survivor benefit under a retirement plan. An agent may make gifts of principal’s property under certain conditions that insure the principal’s decision to authorize gifts is a knowing and informed one. The Act also clarifies an agent’s duty to maintain a principal’s estate plan and the liability an agent incurs for not doing so.

I have removed the old DPOA from my website. I left the Health Care Surrogate and Living Will documents in place. If those documents coincide with your values, then they still can be used by you providing the signing instructions are followed. All Advance Directives need to follow your values and religious beliefs as well as be valid under Florida law and should always be drafted by a qualified Florida attorney. Due to the many choices an individual needs to make in the new Durable Power of Attorney as of October 1, 2011, I feel it is important this document be drafted by a qualified Florida attorney. I do not plan to put the new DPOA on my website.

CRISIS PLANNING REDUX

When Life throws you a 95 mph curve ball called Alzheimer’s, Parkinson’s or Stroke, it is difficult to focus rationally. Emotion rules the day.

At a time when you need to be clear-headed and decisive, you’re overwhelmed, unable to see the forest for all the trees falling on you. Making difficult decisions, putting affairs in order, pursuing the legalities to assure the best financial outcome...these things are best done before that curve ball comes flying at you.

A Florida Bar Certified Elder Law Attorney has the expertise to help you put together a plan that works for you now, and in the future should disaster strike. Our office can help you manage successfully the unimaginable problems you face.

Durable Power of Attorney

Living Will

Will and Trust

Special Needs Trust

Qualified Income Trust

Planning for incapacity utilizing VA benefits, and a host of workable solutions to the problems that arise in the course of comprehensive Life Planning.

Laws change, regulations are rewritten, procedures change too. Planning documents done even five years ago should be reviewed and updated. The new Florida Power of Attorney Act goes
into effect October 1, 2011 with significant changes in the powers granted to the Attorney-in-Fact. I will discuss details of the Act in future Blogs.

Be ready to catch that curve ball if it comes your way. Learn everything you can about rules that may change your life.

NEW ALZHEIMER'S BOOK FOR CAREGIVERS

STAYING AFLOAT IN A SEA OF FORGETFULNESS 

by Gary Joseph Leblanc                           

Staying afloat is exactly what Leblanc helps the caregiver do in times of stress.  The author lived with his beloved Alzheimer’s stricken father for more than nine years as his full-time caregiver.  Caregiving from the unique view of a man is the same story but in a different language:  the language of love on an exceptionally practical level.  Leblanc has a common sense approach to caregiving and labors under no delusions that this is an easy job anyone can do. 

As he learned the tips and tricks on his own, the author began writing a weekly column for the local newspaper, and these columns grew into the book he published after his father’s demise.  One of Leblanc’s cardinal rules was to Keep It Simple.  He found that a strict daily routine suited the lifestyle of an Alzheimer’s patient more than anything else.  Leblanc urges caregivers to be aware of the stress they will encounter as they continue day after day this unrelenting duty to the patient.  Feelings of guilt, loneliness, depression, irritability and being overwhelmed plague the best of caregivers.  Finding ways to alleviate these symptoms benefits both the caregiver and the patient.

Read the entire review at Charlie’s website:  www.charlie-robinson.com. 

 

GRANNY DUMPING FOR PROFITS

Florida’s most vulnerable elders are going to be dumped literally out in the cold so that managed care organizations can make a profit.

Hello.  I’m Charlie Robinson an Elder Law Attorney in Clearwater, Florida.  I am a Board member and past President of Area Agency on Aging of Pasco-Pinellas, Inc., Board Member of Florida Council On Aging , Vice-Chair of the Dept. of Elder Affairs Advisory Council, past Chair of the Florida Bar Elder Law Section and daily advocate for Florida’s senior citizens.  The following is my testimony at the public hearing before the Agency for Health Care Administration June 15, 2011, on the Florida Medicaid reform legislation passed in 2011:

Florida is poised to place thousands of long term care patients at risk of literally being left out in the cold without services. 

Florida’s current system is unsustainable. We have 60,000 plus on waiting lists for senior services. Our AAA averages over 2,000 people on waiting lists for Pasco and Pinellas alone. I strongly believe that the legislation passed as HB 7107 is going to make our problems worse, not better. The recession has added many to the Medicaid rolls and our current system will break at some point and that point is not far away. Any one of several challenges can break our system. Alzheimer’s disease without a cure can break the system. The runaway instance of autism in children can break our system. The baby boomers cannot expect the services that have been delivered under the current system with the age tsunami that is coming soon.

Our challenge is to design a new system that works. That is not what is happening in Florida. We are taking a system that has been deemed a failure by every neutral organization that has studied the six year Managed Care Demonstration project in Broward, Duval, and the rural counties around Duval. What do you do when it is clear that the experiment is a bust? You choose a different population, in this case elders, and you make it statewide. This is like the retailer logic that “We will lose money on every sale but make it up in volume.”

Based on budget concerns in difficult economic times, Florida has passed legislation that will provide bonuses to managed care organizations for dumping Florida’s seniors out of nursing homes.  Remember years ago when family members were accused of granny dumping into nursing homes. Now we will see granny dumping out of the nursing home. These provisions incentivizing discharge from nursing homes will cause life-threatening harm to Florida’s most fragile and vulnerable citizens.  It creates a profit incentive for managed care organizations to discharge long term care patients from skilled nursing facilities and can only be described as “Granny dumping for profit.” Even worse yet, granny may have to get on a brand new waiting list to access services that don’t meet her care needs in the community.

According to the May 27^th 2011 edition of HealthNews Florida, Florida HMOs enjoyed $675 million dollars profit in 2010.

Florida’s Medicaid Reform legislation replaces the current level of care, which is determined by the verifiable criteria based on activities of daily living and level of cognitive impairment, with ambiguous need for care criteria that appear to be based on vague and indeterminate risk assessments.  Managed care companies will be paid bonuses for evicting the elderly from nursing homes based on vague, arbitrary need for care determinations.

Protections and grievance procedures to prevent these evictions and other egregious violations by managed care plans, if they exist, are inadequate and insufficient to protect Florida’s most fragile and vulnerable citizens. 

The irreparable harm that will be brought upon Florida’s most defenseless citizens by this scheme is made even more deplorable when other provisions in Medicaid Reform are taken into account.  There is no validated data to track inappropriate denials of coverage or fraud in this system so Granny dumping for profit will go undetected by the minimal regulatory system.  Further, the at risk citizens who will be evicted, can be dumped into unsafe environments with no services and no funding available for life-saving services because Florida’s Medicaid Reform states there is no right or guarantee for home and community based services despite the profit incentive to managed care organizations to put them there.  These vulnerable elders can then be subjected to share of cost requirements for services that exceed their income, making necessary and life-saving care beyond their reach. 

This scheme was passed on the hope of saving money for Florida’s tax payers.  There is no evidence that Florida’s tax payers will save money with this scheme to dump Florida’s elders for profit.  However, there is ample proof in Florida, including a recent expose that grabbed national attention, that there is little or no protection for Florida’s most helpless citizens whose last hope and only safety net is Florida’s Medicaid program and the life-saving services it funds.

The Nursing Home Diversion program experience is a terrifying model for the new managed care program. Diversion does not pay a penny for room and board. Some assisted living facilities accept granny’s retirement income as her room and board charge but they don’t have to do so. We have seen many situations that work exactly like this 1,2,3 example:

        The ALF charges $3,000 per month, allocating their bill as $1,000 for care and $2,000 for room and board. Diversion provider pays approximately $1,000 per month to the ALF out of the capitated rate of $1,600. Granny’s assets are under $2,000 and her only source of income is her Social Security check of $1,000 per month. That leaves her $1,000 short of the ability to pay her share of cost to the ALF. If there is not a family member able to pick up $1,000 per month shortfall, granny is on the street. If she is married and her husband pays the $1,000 difference, he is being impoverished. It is rare in these economic times that the adult children, struggling financially in their own right, are able to make up the shortfall.

Given the imminent, irreparable danger to and the inadequate safeguards, funding and protections for dual eligibles, those persons qualified for both Medicare and Medicaid  and Florida’s elderly who need long term care, combined with inadequate resources and lack of experience to address the special healthcare needs of these fragile and vulnerable citizens , they must be excluded from this experiment.

Instead, let us challenge our best, brightest, and most experienced Floridians to work together designing a new system that will start with more commitment to the aging services community to provide home-based services and get rid of the waiting lists. The inability to receive community based care results in more nursing home admissions.

We don’t need managed care gatekeepers to add to the expense burden. Florida should be the living laboratory to figure out how to handle the age wave to provide innovative solutions. This managed care fiasco is a big step backwards for a Florida that can’t afford to drive in reverse much longer.

 

SEMINARS TARGET VETS WITH UNWISE INVESTMENTS

We are finding in assisted living facilities unscrupulous investment advisors who are marketing themselves as VA experts.  At seminars and free lunches, they offer to meet with veterans and surviving spouses at no charge.  Typically they have patriotic sounding names.  Incredible harm is done by these bogus advisors who promise to secure the veteran or surviving spouse VA pension benefits;  however, they ignore (or are unaware of) the possibility that Medicaid will be necessary in the near future to pay for more extensive care needs of the veteran or surviving spouse.  As illustrated in the AARP article, I have seen too many cases where the veteran’s assets are gifted to a family member, and a high-commission annuity for a long term is sold to the family member with disastrous results.  From clients I learned of situations where the family member had to declare bankruptcy after the gift is made.  If the family member tells the bankruptcy court it is really grandpa’s money, he or she is admitting to VA fraud.  If the money is claimed as an asset of the bankrupt person, it must be used to pay that grandchild’s debts.  Remember if things appear to be too good to be true, they probably are not true.

For the complete article from the AARP Bulletin titled TAKING AIM AT OLD SOLDIERS, go to the AARP website:      http://www.aarp.org/money/scams-fraud/ and in the upper right “search” box enter “taking aim at old soldiers”.

PALM BEACH POST EDITORIAL IN OPPOSITION TO MEDICAID REFORM, March 17, 2011

Florida Medicaid reform will need reforming:  Don’t just expand managed care.    It would be too much like right for the Legislature to try creative solutions for the state’s burgeoning Medicaid crisis.  Instead, legislators are ready to take the expedient way out, by expanding statewide a five-county test program that even state analysts say isn’t working.

Since 2009, because of the economy, the number of Floridians on Medicaid has gone from an average of 2.4 million per month to nearly 3 million.  Bills in the House and Senate would force Medicaid patients into managed care programs that ostensibly would save the state money.  Studies by the University of Florida and The Associated Press, though, found flaws in the test program.

The Senate bill, crafted by Republican Joe Negron of Stuart, does improve on last year's version by offering consumer protections, such as requiring managed care organizations to spend at least 90 percent of revenues on health care. The federal Affordable Care Act requirement for insurers is 85 percent. The Senate would pay doctors at 100 percent of Medicare rates, which are significantly higher than existing Medicaid rates. That would increase access. The measure rightfully would exclude from managed care the developmentally disabled and seniors in nursing homes. The House version has no such exclusions.

Critics have assailed the Senate measure for capping the amount that can be spent on each patient, but the state's resources are not infinite. "Medicaid benefits are extraordinarily generous," Sen. Negron said. "We're trying to create a Medicaid benefit comparable to what someone in the private sector receives."

The worst part of the Senate bill, which should not be in any final legislation, would allow Florida to withdraw from Medicaid if the federal government does not grant waivers for statewide, mandated managed care. Florida then would be responsible for the entire Medicaid bill, leaving many without care.

Of the $20 billion the state expects to spend on Medicaid next year - up from $14.8 billion in fiscal 2008, when the financial crisis hit - $12 billion comes from Washington. Medicaid supports "our hospitals, our nursing homes, our communities," said Laura Goodhue, executive director of Florida Community Health Action Information Network, which opposes the reform bills. "It would have a huge multiplier effect if we lost that money."

The House bill would make the transition to statewide managed care over five years, beginning in July 2012. That makes far more sense than the Senate's starting point of December. Both bills would allow networks sponsored by doctors and hospitals to compete with HMOs. Given the bad track record of HMOs in the test program - several pulled out when they couldn't make a profit - this change is essential. The Senate version would let accountable care organizations also compete. Such groups have a track record of saving money and improving health outcomes.

Medicaid is the second-biggest item in the state budget, after education, and reform will be one of this year's biggest bills. Since the basic premise, statewide managed care, is faulty, legislators should take the best of each bill, then prepare to start over again if it turns out that they were wrong.